Relationship between the level of physical activity and markers of cardiovascular health in Valencian adolescents (Spain).

INTRODUCTION: A sedentary lifestyle is not only a major cardiovascular risk factor from an early age, it also contributes to the development of other cardiovascular risk factors. The objective of this study was to determine the level of physical activity and relate it to cardiovascular risk markers in Valencian adolescents according to their anthropometric characteristics and gender. POPULATION AND METHODS: The following variables were assessed in a randomized sample of 583 Valencian adolescents (Spain) aged 12-18 years: level of physical activity, using a validated questionnaire; weight, height and waist circumference; aerobic capacity, using the multi-stage ftness test (Course-Navette test); and muscle strength, using a manual dynamometry. RESULTS: In total, 57.60% of male adolescents and 14% of female adolescents complied with the recommendations for physical activity. The prevalence of excessive weight, waist circumference with risk, and aerobic capacity with risk was 24.90%, 29.30% and 20.60%, respectively among boys, and 15.10%, 23.20% and 24.70% among girls (p <0.005). CONCLUSIONS: A higher level of physical activity in adolescents is related to a lower body mass index, a smaller waist circumference and less excessive weight in male adolescents, and to a higher aerobic capacity and a lower cardiovascular risk in both male and female adolescents. Aerobic capacity and waist circumference with risk are signifcantly higher among subjects with excessive weight.

Relationship between the level of physical activity and markers of cardiovascular health in Valencian adolescents (Spain) / Relación del nivel de práctica de actividad física con marcadores de salud cardiovascular en adolescentes valencianos (España)

Introduction. A sedentary lifestyle is not only a major cardiovascular risk factor from an early age, it also contributes to the development of other cardiovascular risk factors. The objective of this study was to determine the level of physical activity and relate it to cardiovascular risk markers in Valencian adolescents according to their anthropometric characteristics and gender. Population and Methods. The following variables were assessed in a randomized sample of 583 Valencian adolescents (Spain) aged 12-18 years: level of physical activity, using a validated questionnaire; weight, height and waist circumference; aerobic capacity, using the multi-stage ftness test (Course-Navette test); and muscle strength, using a manual dynamometry. Results. In total, 57.60% of male adolescents and 14% of female adolescents complied with the recommendations for physical activity. The prevalence of excessive weight, waist circumference with risk, and aerobic capacity with risk was 24.90%, 29.30% and 20.60%, respectively among boys, and 15.10%, 23.20% and 24.70% among girls (p <0.005). Conclusions. A higher level of physical activity in adolescents is related to a lower body mass index, a smaller waist circumference and less excessive weight in male adolescents, and to a higher aerobic capacity and a lower cardiovascular risk in both male and female adolescents. Aerobic capacity and waist circumference with risk are signifcantly higher among subjects with excessive weight.(AU)

Introducción. El sedentarismo no solo es un factor de riesgo cardiovascular importante desde edades tempranas, sino que además contribuye al desarrollo de otros factores de riesgo cardiovascular. El objetivo de este trabajo fue determinar el nivel de práctica de actividad física y relacionarlo con marcadores de riesgo cardiovascular en adolescentes valencianos, según las características antropométricas y el género. Población y métodos. En una muestra aleatoria de 583 adolescentes valencianos (España), de 12 a 18 años, se evaluó el nivel de práctica de actividad física mediante un cuestionario validado; el peso, la talla y la circunferencia abdominal; la capacidad aeróbica mediante la prueba de Course-Navette y la fuerza muscular mediante la dinamometría manual. Resultados. Cumplían las recomendaciones de práctica de actividad física el 57,60% de los varones y el 14% de las mujeres. La prevalencia de exceso de peso, circunferencia abdominal con riesgo y capacidad aeróbica con riesgo fue de 24,90%, 29,30% y 20,60%, respectivamente en los varones y de 15,10%, 23,20% y 24,70% en las mujeres (p < 0,005). Conclusiones. Un mayor nivel de práctica de actividad física en los adolescentes se relaciona con menor índice de masa corporal, menor circunferencia abdominal y menor exceso de peso en los varones, y con mayor capacidad aeróbica y menor riesgo cardiovascular en ambos sexos. La capacidad aeróbica con riesgo y la circunferencia abdominal con riesgo son signifcativamente mayores en los sujetos con exceso de peso.(AU)

Relationship between the level of physical activity and markers of cardiovascular health in Valencian adolescents (Spain) / Relación del nivel de práctica de actividad física con marcadores de salud cardiovascular en adolescentes valencianos (España)

Introduction. A sedentary lifestyle is not only a major cardiovascular risk factor from an early age, it also contributes to the development of other cardiovascular risk factors. The objective of this study was to determine the level of physical activity and relate it to cardiovascular risk markers in Valencian adolescents according to their anthropometric characteristics and gender. Population and Methods. The following variables were assessed in a randomized sample of 583 Valencian adolescents (Spain) aged 12-18 years: level of physical activity, using a validated questionnaire; weight, height and waist circumference; aerobic capacity, using the multi-stage ftness test (Course-Navette test); and muscle strength, using a manual dynamometry. Results. In total, 57.60% of male adolescents and 14% of female adolescents complied with the recommendations for physical activity. The prevalence of excessive weight, waist circumference with risk, and aerobic capacity with risk was 24.90%, 29.30% and 20.60%, respectively among boys, and 15.10%, 23.20% and 24.70% among girls (p <0.005). Conclusions. A higher level of physical activity in adolescents is related to a lower body mass index, a smaller waist circumference and less excessive weight in male adolescents, and to a higher aerobic capacity and a lower cardiovascular risk in both male and female adolescents. Aerobic capacity and waist circumference with risk are signifcantly higher among subjects with excessive weight.

Introducción. El sedentarismo no solo es un factor de riesgo cardiovascular importante desde edades tempranas, sino que además contribuye al desarrollo de otros factores de riesgo cardiovascular. El objetivo de este trabajo fue determinar el nivel de práctica de actividad física y relacionarlo con marcadores de riesgo cardiovascular en adolescentes valencianos, según las características antropométricas y el género. Población y métodos. En una muestra aleatoria de 583 adolescentes valencianos (España), de 12 a 18 años, se evaluó el nivel de práctica de actividad física mediante un cuestionario validado; el peso, la talla y la circunferencia abdominal; la capacidad aeróbica mediante la prueba de Course-Navette y la fuerza muscular mediante la dinamometría manual. Resultados. Cumplían las recomendaciones de práctica de actividad física el 57,60% de los varones y el 14% de las mujeres. La prevalencia de exceso de peso, circunferencia abdominal con riesgo y capacidad aeróbica con riesgo fue de 24,90%, 29,30% y 20,60%, respectivamente en los varones y de 15,10%, 23,20% y 24,70% en las mujeres (p < 0,005). Conclusiones. Un mayor nivel de práctica de actividad física en los adolescentes se relaciona con menor índice de masa corporal, menor circunferencia abdominal y menor exceso de peso en los varones, y con mayor capacidad aeróbica y menor riesgo cardiovascular en ambos sexos. La capacidad aeróbica con riesgo y la circunferencia abdominal con riesgo son signifcativamente mayores en los sujetos con exceso de peso.

Relationship between the level of physical activity and markers of cardiovascular health in Valencian adolescents (Spain). / Relationship between the level of physical activity and markers of cardiovascular health in Valencian adolescents (Spain).

INTRODUCTION: A sedentary lifestyle is not only a major cardiovascular risk factor from an early age, it also contributes to the development of other cardiovascular risk factors. The objective of this study was to determine the level of physical activity and relate it to cardiovascular risk markers in Valencian adolescents according to their anthropometric characteristics and gender. POPULATION AND METHODS: The following variables were assessed in a randomized sample of 583 Valencian adolescents (Spain) aged 12-18 years: level of physical activity, using a validated questionnaire; weight, height and waist circumference; aerobic capacity, using the multi-stage ftness test (Course-Navette test); and muscle strength, using a manual dynamometry. RESULTS: In total, 57.60

of male adolescents and 14

of female adolescents complied with the recommendations for physical activity. The prevalence of excessive weight, waist circumference with risk, and aerobic capacity with risk was 24.90

, 29.30

and 20.60

, respectively among boys, and 15.10

, 23.20

and 24.70

among girls (p <0.005). CONCLUSIONS: A higher level of physical activity in adolescents is related to a lower body mass index, a smaller waist circumference and less excessive weight in male adolescents, and to a higher aerobic capacity and a lower cardiovascular risk in both male and female adolescents. Aerobic capacity and waist circumference with risk are signifcantly higher among subjects with excessive weight.

Gynecological characteristics related to breast cancer in pre and postmenopausal women.

BACKGROUND: The objective of this study was two fold: to identify gynecological characteristics that distinguish women diagnosed with early-stage breast cancer from those at more advanced stages; to identify distinguishing characteristics between premenopausal and postmenopausal women diagnosed with the same stage. POPULATION AND METHOD: 186 incident cases diagnosed with breast cancer were identified out of the 685 patients who were seen to in 2000-2001. The variables to be studied were obtained by means of a specific questionnaire which collected data concerning reproductive characteristics and contraceptive types. RESULTS: Significant differences in the mean age were found, since the early-stage group was younger (57.01+/-12.82 vs. 65.06+/-15.11). Characteristic factors found in pre-menopausal women were: early menopause, they either had no children or a single child, no breastfeeding practice and a more extensive use of contraceptives. Postmenopausal women presented more advanced stages, more pregnancies and less abortions. CONCLUSIONS: By taking the obtained results into consideration, it would be recommendable to bring forward the age at which women are to be included in early detection programmes, and to conduct a follow-up of those women who present such factors to favour an earlier diagnosis of the disease.

[Application of the Gail method of calculating risk in the population of Valencia]. / Aplicación del método de Gail de cálculo de riesgo de cáncer de mama a la población valenciana.

BACKGROUND: The objective of this study was to verify whether the method defined by Gail is applicable and predictive in a population of women in Valencia (Spain). POPULATION AND METHODS: Of the 685 patients diagnosed with breast cancer and attended-to in 2000-2001, 186 incident cases were identified. The variables studied were obtained from a specific questionnaire which included characteristics of reproductive history, number of biopsies and contraceptive pill consumption prior to the diagnosis. Using the model of the National Surgical Adjuvant Breast and Bowel Project (NSABP), an adaptation of the Gail model, the risk of developing breast cancer at 5 years was estimated. RESULTS: Only 40% of those women diagnosed as having breast cancer would have been identified as a high-risk patient by the Gail method. With our population group, the method detected the elderly women with a medical history of breast cancer who developed advanced stage disease. CONCLUSIONS: The Gail method does not adapt well to the study population of Valencia. It would be necessary to add other risk-factors to the Gail method so as to identify more patients in our area.

[Home hospitalization in light of demographic changes and new health challenges]. / La hospitalización domiciliaria ante los cambios demográficos y nuevos retos de salud.

OBJECTIVE: Today, the most important demographic change taking place is the rapid aging of the population. While this phenomenon is having a growing and profound impact on all spheres of society, its greatest impact is in the health area, affecting all levels of health care and leading to the need for new resources and new structures. Out of that, in many countries have come different alternatives as well as in-patient, outpatient, and in-home programs that are geared toward improving health care and helping set priorities. One of these new initiatives is home hospitalization, or home health care. One objective of this study was to describe and analyze the characteristics of a population in Spain that was assisted through home hospitalization (HH). Another objective of the study was to comment on the role that HH can play as a mechanism for integration and coordination between health care levels, in the face of the challenges occurring with the reorganization of health care policies and programs, especially those directed at the elderly. METHODS: A retrospective descriptive study was done of patients assisted through HH in Sanitary Area 9 of the Autonomous Community of Valencia, which is on the eastern coast of Spain. The area's population was 321,361, of whom 60,079 (18.7%) were 60 or older, including 43,044 (13.4%) who were 65 or older. A descriptive study of the analyzed variables was done, with the mean and standard deviation being computed for quantitative variables, and the absolute and relative frequencies (percentages) being calculated for the qualitative variables. RESULTS: Of the patients studied, 78% of them were 65 or older, with an average age of 73 years. They were predominantly women. Of the total group, 72% of them had chronic diseases, and 67% had at least one associated secondary diagnosis. There was an important problem of communication between the two principal levels of care, primary care and hospital care, which obviously had an impact on the patients and on the quality and effectiveness of their health care. Furthermore, it was found that HH finds its greatest utility with and is an effective tool for an adult or elderly population that has multiple chronic degenerative or terminal diseases. CONCLUSIONS: The results of this study highlight the need to create or strengthen channels and mechanisms for interinstitutional communication that will guarantee continuity of care. The ongoing, effective care of the health and well-being of elderly persons requires different levels of health interventions. This care should be comprehensive, adequate, integrated, of high quality, humanized, timely, and coordinated between the two principal levels of health care. In the final analysis, these factors will determine the quality of the health care for geriatric patients and the capacity to solve their health problems.

La hospitalización domiciliaria ante los cambios demográficos y nuevos retos de salud / Home hospitalization in light of demographic changes and new health challenges

Objetivos. En la actualidad, el fenómeno demográfico más importante es el rápido envejecimiento de la población, que tiene un creciente y profundo impacto en todos los ámbitos de la sociedad, aunque su mayor trascendencia es en la sanidad, tanto por su repercusión en todos los niveles asistenciales como por la necesidad de nuevos recursos y estructuras. De ahí que se hayan desarrollado en muchos países diferentes alternativas y programas institucionales, ambulatorios y domiciliarios, encaminados a mejorar la situación sanitaria y a auxiliar en el proceso de establecer prioridades. La hospitalización domiciliaria (HD) es una de ellas. El objetivo de este estudio consistió en describir y analizar las características de la población asistida en HD, y en comentar el papel de la HD como mecanismo de integración y coordinación entre niveles, frente al reto de la reorganización de políticas y proyectos de atención sanitaria, especialmente los dirigidos a la población anciana. Métodos. Se realizó un estudio descriptivo, retrospectivo, de una serie de pacientes asistidos en HD en el área sanitaria número 9 de la Comunidad Valenciana, España, con una población de referencia de 321 361 habitantes, de los cuales 60 079 (18,7%) son personas de 60 años o más, y 43 044 (13,4%), de 65 años o más. Se realizó un estudio descriptivo de las variables analizadas, calculándose la media y la desviación estándar para las variables cuantitativas, y las frecuencias absoluta y relativa (porcentaje) para las variables cualitativas. Resultados. El perfil de los pacientes estudiados corresponde a ancianos (el 78% con 65 años o más; media de 73 años), predominantemente del sexo femenino, con enfermedades crónicas (72%) y múltiples enfermedades asociadas (el 67% tenía al menos un diagnóstico secundario asociado). Se constató la existencia de un importante problema de comunicación entre los dos principales niveles de atención (primaria y hospitalaria), que obviamente repercute en los pacientes y en la calidad y eficacia de la asistencia sanitaria. Asimismo, se verificó que la HD encuentra todo su significado en la población adulta o anciana con múltiples enfermedades crónicas degenerativas o terminales, en la que ha demostrado ser una herramienta eficiente. Conclusiones. Se destaca la necesidad de crear o potenciar los canales y mecanismos de comunicación interinstitucional que garanticen la continuidad del proceso asistencial. La asistencia continua y eficaz de la salud y bienestar del anciano requiere diferentes niveles de intervención sanitaria y debe estar basada en lo que hoy es un objetivo inaplazable: la atención integral, adecuada, de calidad, humanizada, oportuna y basada en una asistencia integrada y coordinada entre los dos principales niveles de atención sanitaria. Son estos factores los que, en última instancia, determinan la calidad de la asistencia y la capacidad resolutiva de los problemas asistenciales planteados en la atención al paciente geriátrico.

Objective. Today, the most important demographic change taking place is the rapid aging of the population. While this phenomenon is having a growing and profound impact on all spheres of society, its greatest impact is in the health area, affecting all levels of health care and leading to the need for new resources and new structures. Out of that, in many countries have come different alternatives as well as in-patient, outpatient, and in-home programs that are geared toward improving health care and helping set priorities. One of these new initiatives is home hospitalization, or home health care. One objective of this study was to describe and analyze the characteristics of a population in Spain that was assisted through home hospitalization (HH). Another objective of the study was to comment on the role that HH can play as a mechanism for integration and coordination between health care levels, in the face of the challenges occurring with the reorganization of health care policies and programs, especially those directed at the elderly. Methods. A retrospective descriptive study was done of patients assisted through HH in Sanitary Area 9 of the Autonomous Community of Valencia, which is on the eastern coast of Spain. The area's population was 321 361, of whom 60 079 (18.7%) were 60 or older, including 43 044 (13.4%) who were 65 or older. A descriptive study of the analyzed variables was done, with the mean and standard deviation being computed for quantitative variables, and the absolute and relative frequencies (percentages) being calculated for the qualitative variables. Results. Of the patients studied, 78% of them were 65 or older, with an average age of 73 years. They were predominantly women. Of the total group, 72% of them had chronic diseases, and 67% had at least one associated secondary diagnosis. There was an important problem of communication between the two principal levels of care, primary care and hospital care, which obviously had an impact on the patients and on the quality and effectiveness of their health care. Furthermore, it was found that HH finds its greatest utility with and is an effective tool for an adult or elderly population that has multiple chronic degenerative or terminal diseases. Conclusions. The results of this study highlight the need to create or strengthen channels and mechanisms for interinstitutional communication that will guarantee continuity of care. The ongoing, effective care of the health and well-being of elderly persons requires different levels of health interventions. This care should be comprehensive, adequate, integrated, of high quality, humanized, timely, and coordinated between the two principal levels of health care. In the final analysis, these factors will determine the quality of the health care for geriatric patients and the capacity to solve their health problems

La hospitalización domiciliaria: antecedentes, situación actual y perspectivas / Home hospitalization: background, current situation,and future prospects

Objetivo. Determinar las distintas variantes que ha tenido el concepto de la hospitalización domiciliaria a lo largo del tiempo, para así contribuir al debate sobre las circunstancias que inciden en la gestión sanitaria frente a futuros retos. Métodos. Se revisa la literatura sobre la atención domiciliaria como modalidad asistencial de salud mediante una exploración de las publicaciones indizadas en MEDLINE, LILACS y el Índice Médico Español durante el período de 1995­2000. Resultados. La hospitalización domiciliaria ha tenido un desarrollo desigual a lo largo del tiempo en diferentes países y son varios los modelos de este tipo de atención, cada uno con sus respectivas ventajas y desventajas. Conclusiones. Se definen algunos criterios y propuestas que podrían enmarcar una gestión domiciliaria innovadora, efectiva y de calidad. Se concluye que la atención domiciliaria podría contribuir a diseñar y establecer un modelo consensuado y armonioso de organización y financiación entre los niveles de atención primaria y hospitalaria

Objective. To establish the different forms that the concept of home care has taken over time as a modality for providing health care, so as to contribute to the debate on the circumstances affecting health care management in the face of future challenges. Methods. The literature is reviewed on home care as a method for delivering health care, by researching publications indexed during the period of 1995­2000 in three medical bibliographical databases: MEDLINE, LILACS (Latin American and Caribbean Health Sciences) and the Índice Médico Español (Spanish Medical Index). Results. Home hospitalization has developed differently over time in various countries, with an assortment of models for this type of care, each with its respective advantages and disadvantages. Conclusions. There are some criteria and proposals that could provide a framework for home care that is innovative, effective, and of high quality. Home care could help in the design and creation of a consensus on an organizational and financing model that fits in harmoniously between primary care and care in a hospital